Evaluation of subtle motor deficit signs in patients with monohemispheric brain tumor

THESES

Evaluation of subtle motor deficit signs in patients with monohemispheric brain tumor (abstract)^*. Dissertation. Rio de Janeiro, 2007.

Eliana Teixeira Maranhão^**

INTRODUCTION: One of the several functions of the physical therapist is to identify specific lesions responsible for pain, paralysis, or paresis. This is followed by an evaluation the presentation and integrity of the systems and structures involved, as well as estimating the patient's performance level in his daily occupational and recreational life. Identifying the motor deficit established in the patient's most severe expression does not pose great difficulty, due to the stereotypical aspect in which it is presented. On the other hand, the identification of motor deficits that are subtle to the point that they are not even recognized by the subjects themselves becomes a challenge when using only muscular force tests by confrontation and counter-resistance, which are part of the conventional neurological examination.

OBJECTIVE: This prospective study has the objective of evaluating the sensitivity and the specificity of a series of semiologic tests focusing on subtle motor deficits in patients with monohesmispheric cerebral tumors.

METHOD: We used a blind design to study 94 subjects randomly selected from the Neurosurgery/Neurology ambulatory of INCa, and they were divided in two groups: 1) patients with monohesmipheric cerebral tumor with more than 30 days of evolution and no apparent motor deficit (n=60) and 2) individuals without cerebral tumor (n=30). All subjects underwent a brain magnetic resonance or computed tomography examination, sometimes both. Four individuals were removed from the sample. The Author had no access to clinic histories, neurologic examinations, brain image tests, or diagnoses. Following the mini-mental status examination (Folstein, 1975, required minimum score: 25), thirteen tests were sequentially performed: Spasticity of Conjugate Gaze (SEOC); Platism Sign (SP); Forearm Rolling Test (SRA); Souques Intersosseous Sign (SIS); Pronator Drifting Test (SPr); Mayer Sign (SM); Finger Tapping Sign (SBD); Foot Tapping Sign (SBP); Babinski Sign (SB); Chaddock Sign (SC); Digit Quinti Sign (SQD); and the Digit Quinti Rolling Sign (SRQD).

RESULTS: The sensitivity, specificity, and predictive values of each sign was calculated. The most sensitive tests were: the Digit Quinti Sign (sensitivity 0.51 (Confidence Interval 95%, 0.41 to 0.61)); the Pronator Drifting Test (0.41 (0.31 to 0.51)); the Finger Rolling Test (0.41 (0.31 to 0.51)); the Souques Interosseous Sign (0.23 (0.14 to 0.32)); and the Foot Tapping Test (0.23 (0.14 to 0.32)). The tests with greatest specificity were: SQD 0.70 (0.61 to 0.79); SPr 0.96 (0.92 to 0.99); SRA 0.93 (0.88 to 0.98); SIS 0.80 (0.72 to 0.88); and SBP 0.93 (0.88 to 0.98). The agreement measurement among the three most sensitive signs was 21%.

CONCLUSION: The SRQ, the SPr, and the SRA are simple tests to perform and easy to be interpreted. Their positivity in individuals without apparent motor deficit may point the therapist towards other diagnostic investigations to objectively detect monohemispheric cerebral lesion.

Key words: subtle motor deficit, cerebral tumor, neurologic semiology.

*

Avaliação de sinais de déficit motor sutil em pacientes com tumor cerebral monohemisférico. Dissertação de Mestrado, Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) (Área: Neurologia). Orientadores: Maurice Borges Vincent e Péricles Maranhão-Filho.

Publication Dates

• Publication in this collection
  28 Mar 2008
• Date of issue
  Mar 2008